Family Forums: Designing the Future Title of Presentation 1 Agenda • • • • NYIN.org Value-based Business Model Care Coordination Model Response to the NYS Transformation Agenda Family Forums 2 NYIN.org Family Forums 3 NYIN: Value-based Managed Care NYIN is driven by a simple idea that providers listening to and working with individuals & families can create and design a viable business model that works for everyone. We hold to the ideals of choice, access, and quality of life Family Forums 4 A picture of the new world NYS Medicaid $$$ NYIN DISCO* with Insurance License Network of Providers (Agencies you know) Medicaid Recipients = Enrollees (Persons Served and Families) Access and Choice of Service * DISCO - Developmental Disabilities Individual Supports and Care Organization Family Forums 5 DISCO Benefit Package OPWDD Auspice Services OPWDD Comprehensive Waiver Services Day Treatment ICF/IID Art 16 Clinic Svcs: OT, PT, SLP, Clinical Social Work, Psychology, Nutrition, Rehab Counseling, Podiatry, and Dentistry. Care Coordination provided by the DISCO DOH Auspice Services Adult Day Health Care Dentistry DME and Hearing AIDS Home Care (offered under any auspice: hospital-based, nursing home-based, and free-standing programs) Non Emergency Transportation Optometry/Eyeglasses OT, PT, SLP Personal Care Personal Emergency Response System Private Duty Nursing Psychology and Clinical Social Work Respiratory Therapy Skilled Nursing Facility Podiatry OMH/OASAS Auspice Services OASAS Inpatient OMH Institutional Program (PC/RTF) & private psychiatric hospitalizations Personal Recovery Oriented Services (PROS) Outpatient – OMH, OASAS Psychology and Clinical Social Work OMH day treatment Family Forums 6 Care Coordination Model Current Anticipated Community Linkages and Referrals MSC (Case management) Advocacy/ Life Planning Designated Care Coordinator: Central point of contact Eligibility and Benefits Management/ Assessment Coordination with Providers Family Forums 7 What is Care Coordination? • Provides a person-centered, integrated system for medical, health and social support services • Creates an individual care plan • Connects individuals with all their providers • Ensures timely communication with providers and community supports • Measures, monitors and improves quality informed by individual outcomes • Utilizes electronic information to support integrated and coordinated care Family Forums 8 Responses to NYS Transformation Agenda NYIN will continue to take a leadership role in: • Individual Services and Supports (Self-Direction) • Employment Opportunities: Cleaning with Meaning a “green” home cleaning business run by people with disabilities. • Community Integration: Our Place a new day services model using neighborhood spaces and selfdirected activities. Family Forums 9 What you can do going forward • Take advantage of these Family Forums. Ask questions. • Stay connected to NYIN – NYIN.org • Ensure eligibility for services is formally established through the local DDRO • Stick with or get connect to an agency you know - to maintain continuity of services • Keep informed • Be an advocate Family Forums 10 Contact the NYIN Agency You Know UCP of NYC 212.683.6700 ext 202 Abittigner@ucpnyc.org www.ucpnyc.org HeartShare 718-422-3204 Olga.Golubeva@heartshare.org www.heartshare.org CBHS CBHS@occupations.org 1-888-750-2266 http://www.occupations.org/pdf/CBHS _brochure.pdf YAI LINK 212.273.6182 info@yai.org www.yai.org SUS 212.633.6900 info@sus.org www.sus.org Lifespire 212-741-0100 info@lifespire.org www.lifespire.org IAHD 718-741-0100 andre.thompson@iahdny.org www.iahdny.org Family Forums 11 Agencies You Know Governing Agency Communities Served Coordinated Behavioral Health Services (CBHS)* Westchester, Mid-Hudson Region HeartShare Human Services of New York New York City The Institutes for Applied Human Dynamics (IAHD) New York City, Westchester Lifespire New York City, Lower-Hudson Region Services for the UnderServed (SUS) New York City United Cerebral Palsy of NYC (UCP/NYC) New York City The Young Adult Institute (YAI) New York City, New Jersey, Long Island, Mid-Hudson Region * CBHS is a consortium which includes Abilities First, Crystal Run Village Inc., New Hope Community, Occupations Inc., and Westchester Jewish Community Services Family Forums 12 Business Council members • • • • • • • • Ability Beyond Disability Birch Family Services Camp Venture, Inc. CP Associations of New York State Children’s Village Community Based Services, Inc. Edwin Gould Services Epilepsy Foundation of Metro NY • • • • • F.R.E.E., Inc. Hawthorne Foundation Head Injury Association Opengate, Inc. Richmond Community Servies • The Rose F. Kennedy Center • St. Vincent’s Services • A Very Special Place Family Forums 13 Business Partnership Business Partnership UAM Bd. Observer UCP of NYC Heart Share IAHD YAI SUS CBHS Lifespire Owners Loans Reinsurance Agreement Business Plan DISCO Application NYIN OPWDD UAM $ Costs of Application split 50/50 by NYIN and UAM $ Family Forums 14 Acronyms • • • • • • • • • • • • • • • • • • • • • • ADA – American with Disabilities Act AT – Assistive technology CASA – Community Alternative Systems Agency CDPAP – Consumer Directed Personal Assistance Program CDS – Consumer Directed Services CMS – Centers for Medicare and Medicaid CR – Community Residence CSS – Consolidated Supports and Services DC – Developmental Center DD – Developmental Disabilities DDRO – Developmental Disabilities Regional Office DISCO - Developmental Disability Individual Support and Care Coordination Organizations DOH – Department of Health DQA – Division of Quality Assurance EI – Early Intervention FIDA – Fully Integrated Dual Advantage Programs FSS – Family Support Services HCBS – Home and Community Based Services HIPAA – Health Insurance Portability and Accountability Act HUD – Housing and Urban Development ICF – Intermediate Care Facility ICS – Individual and Community Supports • • • • • • • • • • • • • • • • • • • • • • • • IEP – Individual Education Plan ILC - Independent Living Center IRA – Individualized Residential Alternative ISE – Individualized Service Environment ISP – Individualized Service Plan ISS – Individualized Support Services IWRP – Individual Work Related Plan LCED – Level of Care Eligibility Determination MA – Medicaid MLTCP – Managed Long Term Care Plan MSC – Medicaid Service Coordination NCI – National Core Indicators OPWDD - Office for People with Developmental Disabilities PCP – Person Centered Planning PCP – Primary Care Physician PCSS – Plan of Care Support Services POM – Personal Outcome Measures SA – Self Advocacy SCAP – Service Coordination Activity Plan SCBA – Service Coordination Basic Agreement SD – Self Determination SE – Supported Employment SSDI - Social Security Disability Insurance SSI – Supplemental Security Income Family Forums 15 Developmental Disabilities Individual Support and Care Coordination Organization (DISCO) NYIN, as a DISCO, has developed plans to: • Enroll individuals who voluntarily opt to enroll in 2014-15 • Provide person-centered planning for all individuals enrolled • Handle the flows of funds (per member, per month) • Promote living and active engagement in the most integrated setting • Ensure that each individual who chooses to do so can selfdirect his or her services Family Forums 16